[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Dentistry](https://durgical.com/en/dentistry/) › [Oral mucosal lesions](https://durgical.com/en/dentistry/areas/oral-lesions/) › The tongue: geographic tongue, glossitis and what to worry about # The tongue: geographic tongue, glossitis and what to worry about - Oral pathology Many tongue changes are harmless variants. A smooth red tongue suggests a deficiency; a lump or ulcer on the side needs a biopsy. Updated Nov 12, 2026 **See it in 3D:** [Tongue](https://durgical.com/en/anatomy/tongue/) ## Key points - Geographic tongue moves and is benign. - Smooth red tongue = deficiency until proven otherwise. - Strawberry tongue: scarlet fever or Kawasaki disease. ## What it is The tongue's surface is covered by papillae; changes in them alter its colour and texture. Geographic tongue (benign migratory glossitis) shows smooth red patches with white borders that move over days, is harmless and sometimes sore with spicy food. A fissured tongue is a normal variant, often with geographic tongue. Black hairy tongue is overgrowth of filiform papillae with pigment, linked to smoking, antibiotics and poor hygiene. Atrophic glossitis (a smooth, red, sore tongue) reflects deficiency of iron, vitamin B12, folate or riboflavin, or coeliac disease. A «strawberry tongue» is seen in scarlet fever and Kawasaki disease. Macroglossia suggests hypothyroidism, amyloidosis or acromegaly. ## How to recognise it - Geographic tongue: migrating map-like red patches; benign. - Smooth red tongue: check iron, B12 and folate; consider coeliac disease. - Strawberry tongue in a febrile child: scarlet fever or Kawasaki disease. - Macroglossia: hypothyroidism, amyloidosis, acromegaly, Down syndrome. - A persistent ulcer or lump on the lateral border is suspicious for cancer. ## Differential and risks - Kawasaki disease in a child with five days of fever, red lips and strawberry tongue needs urgent assessment because of coronary risk. - Atrophic glossitis with neuropathy suggests B12 deficiency; treat before folate alone. - Unilateral tongue weakness and deviation point to the hypoglossal nerve (XII). ## Next step / Initial management - Geographic or fissured tongue: reassure; avoid irritant foods during flares. - Smooth sore tongue: full blood count, ferritin, B12 and folate; coeliac serology if indicated; treat the deficiency. - Strawberry tongue with prolonged fever: assess for Kawasaki disease and refer urgently. - Persistent ulcer, lump or induration on the tongue: refer for biopsy. ## Test yourself Think of the answer, then tap the question to see it. ## What is geographic tongue? A benign condition with migrating smooth red patches bordered by white lines on the tongue. ## Which deficiencies cause atrophic glossitis? Iron, vitamin B12, folate and riboflavin, among others; coeliac disease can be the cause. ## Which two febrile illnesses of children cause a strawberry tongue? Scarlet fever and Kawasaki disease. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/dentistry/the-tongue-geographic-tongue-glossitis-and-what-to-worry-about/) ## Elsewhere in DurgiPedia - [Oral cavity, tongue and teeth](https://durgical.com/en/histology/oral-cavity-tongue-and-teeth/) - [Tongue: development and innervation](https://durgical.com/en/embryology/tongue-development-and-innervation/) ## Connections ## See it in 3D 1 The structures of Durgical's 3D anatomy where it is found. - [Tongue](https://durgical.com/en/anatomy/tongue/) ## Related 4 - [Nutritional deficiencies in the mouth](https://durgical.com/en/dentistry/nutritional-deficiencies-in-the-mouth/) - [Burning mouth syndrome](https://durgical.com/en/dentistry/burning-mouth-syndrome/) - [White and red patches in the mouth: approach](https://durgical.com/en/dentistry/white-and-red-patches-in-the-mouth-approach/) - [The systematic oral exam: outside in](https://durgical.com/en/dentistry/the-systematic-oral-exam-outside-in/) ## Related conditions 4 - [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/) - [Pernicious anaemia](https://durgical.com/en/conditions/pernicious-anaemia/) - [Coeliac disease](https://durgical.com/en/conditions/coeliac-disease/) - [Kawasaki disease](https://durgical.com/en/conditions/kawasaki-disease/) [← All of dentistry](https://durgical.com/en/dentistry/) Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once. Sources: [Geographic Tongue](https://www.ncbi.nlm.nih.gov/books/NBK554466/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Glossitis](https://www.ncbi.nlm.nih.gov/books/NBK560627/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Tongue Cancer](https://www.ncbi.nlm.nih.gov/books/NBK562324/) (StatPearls Publishing (NCBI Bookshelf), 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/dentistry/the-tongue-geographic-tongue-glossitis-and-what-to-worry-about/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/dentistry/the-tongue-geographic-tongue-glossitis-and-what-to-worry-about/